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Lee S, Shin J, Kim M, Jo S, Park SH. Assessing the Impact of Nutritional Support Teams on Clinical Outcomes: Compliance and Feasibility of Micronutrient Supplementation. J Clin Med 2024; 13:3422. [PMID: 38929952 PMCID: PMC11204540 DOI: 10.3390/jcm13123422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/21/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Micronutrient (MN) supplementation has a positive impact on clinical outcomes. However, the evidence for the impact of MN supplementation remains controversial. Therefore, our study aims to assess the impact on nutritional outcomes according to exploring the implementation of MN support with multidisciplinary collaboration. Methods: This retrospective cohort study was conducted at a university hospital in Incheon, Korea. All patients referred to a nutrition support team (NST) between July and November 2022 were included. The NST reviews the MN protocol, which includes multivitamins and trace elements, based on international nutrient guidelines. All patients who were on nothing per oral and did not meet ≥70% of their nutritional requirements within 1 week were recommended MN supplements. Compliance with the MN protocol was evaluated, alterations in nutritional status based on the Nutrition Risk Screening 2002 (NRS 2002) scoring system and clinical outcomes were assessed after 7 day and at discharge. Multiple logistic regression analysis was used to identify factors associated with high nutritional risk in discharged patients. In addition, a sub-analysis was performed on changes in the nutritional of patients on the ward and in the ICU. Results: A total of 255 patients were eligible for analysis, with many patients requiring an MN supply of nothing per oral. The rate of implementation of MN supplementation was 50.2%. The findings indicate a significant decrease in the NRS 2002 score in the good compliance group with MN supplementation. No significant differences in protocol compliance were observed in terms of mortality, hospital stay, or length of stay in the intensive care unit. However, bad compliance with MN supplementation was correlated with risk factors for malnutrition at discharge. In subgroup analysis, nutritional status in the ICU and wards improved, with a significant difference between the two groups. Conclusions: The implementation of a MN supplementation protocol by a multidisciplinary NST is a feasible approach for improving the nutritional status of inpatients. Ensuring high compliance with this protocol is crucial, as poor compliance has been identified as a risk factor for malnutrition at discharge. Active intervention by the NST is essential to achieve optimal nutritional outcomes.
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Affiliation(s)
- Sunmin Lee
- College of Pharmacy and Research, Institute of Life and Pharmaceutical Sciences, Sunchon National University, Suncheon 57922, Republic of Korea
| | - Jongbeom Shin
- Division of Gastroenterology, Department of Internal Medicine, InHa Hospital, Incheon 22332, Republic of Korea
| | - Mina Kim
- Department of Nursing, InHa Hospital, Incheon 22332, Republic of Korea
| | - Suejin Jo
- Clinical Nutrition Department, Dongduk Women’s University Graduate School, Seoul 02748, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Soon Chun Hyang University Hospital, Seoul 04401, Republic of Korea
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Amodio E, Schreiber PW, Faes Hesse M, Wolfensberger A. Adverse Outcomes of Patients with Non-Ventilator-Associated Hospital-Acquired Pneumonia (nvHAP)-A Single Centre Cohort Study. Infect Dis Rep 2024; 16:228-238. [PMID: 38525765 PMCID: PMC10961785 DOI: 10.3390/idr16020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Non-ventilator associated hospital-acquired pneumonia (nvHAP) is a common nosocomial infection, but little is known about the outcomes of patients with nvHAP and the risk factors for adverse outcomes. In this retrospective study conducted in a Swiss tertiary care centre, adverse outcomes like in-hospital mortality, intensive care unit (ICU) admission, and mechanical ventilation, both all-cause and nvHAP-associated, were investigated. Of 244 patients with nvHAP, 72 (30%) died, 35 (14%) deaths were attributed to nvHAP. While 36 (15%) patients acquired nvHAP on the ICU, another 173 patients were eligible for ICU-transferral, and 76 (43.9%) needed ICU-admission. Of all patients hospitalized on the ICU 58 (51.8%) needed intubation due to nvHAP. Multivariable logistic regression analysis identified lower body mass index (OR per unit increase: 0.90, 95%CI: 0.82-0.98) and lower haemoglobin on admission (OR per unit in g/l increase: 0.98, 95%CI: 0.97-1.00) as patient specific factors independently associated with nvHAP-associated mortality. Given the frequency of nvHAP adverse outcomes, hospitals should evaluate increasing nvHAP prevention efforts, especially for patients at high risk for nvHAP mortality. To what extent pneumonia prevention interventions do lower nvHAP mortality in these patients is still to be evaluated.
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Affiliation(s)
| | | | | | - Aline Wolfensberger
- Department for Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Gardiner W, Brown K, Richardson H, Pretorius N, Heales L. The incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia in regional Queensland: A retrospective descriptive study. Aust J Rural Health 2023; 31:138-143. [PMID: 36106699 DOI: 10.1111/ajr.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 08/08/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence, characteristics and in-hospital mortality of non-ventilator-associated hospital-acquired pneumonia (NV-HAP) in a regional (Modified Monash Model 2) Australian hospital. METHODS All cases with NV-HAP were obtained from the Business Analysis and Decision Support (BADS) Unit between 1st January 2013 and 31st December 2018. Medical records were reviewed, and data pertaining to incidence, characteristics (age and gender), length of stay, co-morbidities (measured using the Charlson Comorbidity Index) and in-hospital mortality were extracted. Incidence rate was calculated as a proportion of NV-HAP cases per 1000 bed-days. DESIGN A retrospective study design was used to review all cases of NV-HAP between 1 January 2013 and 31 December 2018 at a single regional Australian hospital. Using the Modified Monash Model (MMM), our regional setting is classified as a regional centre (MMM-2). SETTING Rockhampton Hospital, Australia. PARTICIPANTS Patient cases. MAIN OUTCOME MEASURES Incidence rate, Incidence proportion, mortality. RESULTS A total of 501 cases were identified with an incidence rate of 0.98 cases per 1000 bed-days over the study period 2013-2018. Cases with NV-HAP had a median age of 78.2 years (interquartile range 18.8), a median length of stay of 13.0 days (interquartile range 12.0) and a median Charlson Comorbidity Index score of 3.0 out of 39 (interquartile range 3.0), and a greater proportion was male (n = 297, 57%). The in-hospital mortality rate for NV-HAP cases was 18.9%. CONCLUSION This study revealed an overall incidence rate of 0.98 cases per 1000 bed-days from 2013 to 2018 in a regional Australian hospital. In addition, this study provided the descriptive characteristics for patients with NV-HAP at our regional hospital.
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Affiliation(s)
- Wenonah Gardiner
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Kassandra Brown
- Department of Speech Pathology, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Heather Richardson
- Aged Care, Clinical and Rehabilitation Services, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Nellie Pretorius
- Oral Health Department, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia.,School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Luke Heales
- School of Health, Medical and Applied Sciences, College of Health Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Carey E, Chen HYP, Baker D, Blankenhorn R, Vega RJ, Ho M, Munro S. The association between non-ventilator associated hospital acquired pneumonia and patient outcomes among U.S. Veterans. Am J Infect Control 2022; 50:1339-1345. [PMID: 35231564 DOI: 10.1016/j.ajic.2022.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Non-ventilator associated hospital acquired pneumonia (NV-HAP) affects approximately 1 in 100 hospitalized patients yet risk-adjusted outcomes associated with developing NV-HAP are unknown. METHODS Retrospective cohort study with propensity score matched populations (NV-HAP vs no NV-HAP), using ICD-10 codes for bacterial pneumonia not present on admission. Outcomes included the patient level probability of NV-HAP developing among acute care non-transfer admissions in 133 Veterans Affairs hospitals and subsequent mortality, length of stay, inpatient sepsis, and 12-month costs. RESULTS NV-HAP occurred in 0.6% of Veteran admissions. Among admissions that developed NV-HAP, the mean length of stay of 26.3 days (6.72 days among non-NV-HAP), 30-day mortality was 18.4% (4.5% among non-NV-HAP), 1-year mortality was 47.8% (21.4% among non-NV-HAP), and total median 12-month direct medical costs were $138,136.32 ($64,357.21 among non-NV-HAP). Inpatient sepsis occurred in approximately 20% of NV-HAP admissions (0.7% among non-NV-HAP). Data available at admission was insufficient to identify high and low risk patient groups. CONCLUSIONS NV-HAP is associated with severely worse patient outcomes and increased costs of care up to 12 months post-episode. Since population risk stratification is not feasible, prevention efforts should be directed at the full population of hospitalized Veterans.
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Affiliation(s)
- Evan Carey
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, CO, Seattle, WA, Cleveland, OH; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Auora, CO.
| | - Hung-Yuan P Chen
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, CO, Seattle, WA, Cleveland, OH
| | - Dian Baker
- School of Nursing, California State University, Sacramento, CA
| | - Richard Blankenhorn
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, CO, Seattle, WA, Cleveland, OH
| | - Ryan J Vega
- Office of Healthcare Innovation and Learning, Veterans Health Administration, Washington, DC; Department of Internal Medicine, George Washington School of Medicine and Health Sciences, Washington DC
| | - Michael Ho
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A virtual center based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers; Aurora, CO, Seattle, WA, Cleveland, OH; Department of Medicine, Division of Cardiology, University of Colorado Denver - Anschutz Medical Campus, Denver, CO
| | - Shannon Munro
- Research and Development, Salem VA Medical Center, Salem, VA
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Yu Y, Zheng P. Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: What can we do? PLoS One 2022; 17:e0273350. [PMID: 35998192 PMCID: PMC9398012 DOI: 10.1371/journal.pone.0273350] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative pneumonia is a serious complication in elderly patients with hip fracture. It is necessary to identify the influencing factors of postoperative pneumonia in patients with hip fracture. METHODS Elderly patients with hip fractures admitted to a tertiary hospital in China from January 1, 2020 to August 31, 2021 were included. The characteristics of patients with and without postoperative pneumonia were evaluated and compared. Logistic multivariate regression analyses were conducted to assess the risk factors of postoperative pneumonia. RESULTS 267 patients with hip fracture were included, the incidence of postoperative pneumonia in patients with hip fracture was 13.11%. There were significant differences in the age, diabetes mellitus, anemia, hypoalbuminemia, anesthesia method and duration of surgery between infection and no infection group, no significant differences in the gender, BMI, hypertension, hyperlipidemia, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase, estimated blood loss during surgery were detected between infection and no infection group. Logistic regression analysis showed that age≥70y (OR2.326, 95%CI1.248~3.129), diabetes mellitus (OR2.123, 95%CI1.021~3.551), anemia (OR3.199,95%CI1.943~5.024), hypoalbuminemia (OR2.377, 95%CI1.211~3.398), general anesthesia (OR1.947, 95%CI1.115~3.038), duration of surgery≥120min (OR1.621, 95%CI1.488~2.534) were the risk factors of postoperative pneumonia in elderly patients with hip fracture (all p<0.05). Escherichia Coli (33.33%), Klebsiella pneumoniae (28.57%), Staphylococcus aureus (21.43%) were the most common bacteria of pulmonary infection. CONCLUSION There are many risk factors for postoperative pneumonia in elderly patients with hip fractures after surgery. In clinical practice, medical workers should take targeted interventions for those risk factors to reduce postoperative pneumonia.
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Affiliation(s)
- Yibing Yu
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan Orthopedic Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiwen Zheng
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan Orthopedic Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dos Santos HAV, Leandro-Merhi VA. Can the Nutritional Risk Screening (NRS-2002) predict unfavorable clinical outcome in hospitalized elderly patients? Aging Clin Exp Res 2022; 34:1165-1169. [PMID: 34993907 DOI: 10.1007/s40520-021-02032-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of malnutrition in hospitalized elderly patients (HEP) is high. OBJECTIVE To investigate the behavior of several nutritional indicators and predictors of unfavorable clinical outcome. METHODS Retrospective study with hospitalized elderly patients (N = 322). Nutritional instruments, indicators and outcome were investigated. Chi-square, Fisher and Mann-Whitney tests and univariate and multiple logistic regression analysis were used. RESULTS The variables that, jointly, were associated with hospital stay longer than 7 days, include: the presence of complications (p = 0.0328; OR 1.946; IC95% 1.056; 3.585) and nutritional risk according to the NRS-2002 (p = 0.0016; OR 2.080; IC95% 1.322; 3.275). The variable that remained associated with complications in the multiple model was the nutritional risk according to the NRS-2002 (p = 0.0018; OR 2.587; IC95% 1.423; 4.703). CONCLUSION Nutritional risk using the NRS-2002 is a predictor of clinical outcome in hospitalized elderly patients.
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Affiliation(s)
| | - Vânia Aparecida Leandro-Merhi
- Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas (PUC Campinas), Av. John Boyd Dunlop, s/n-Jardim Ipaussurama, Campinas, SP, 13034-685, Brazil.
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Bellanti F, lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients 2022; 14:910. [PMID: 35215559 PMCID: PMC8880030 DOI: 10.3390/nu14040910] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 02/05/2023] Open
Abstract
Malnutrition in hospitalized patients heavily affects several clinical outcomes. The prevalence of malnutrition increases with age, comorbidities, and intensity of care in up to 90% of old populations. However, malnutrition frequently remains underdiagnosed and undertreated in the hospital. Thus, an accurate screening to identify patients at risk of malnutrition or malnourishment is determinant to elaborate a personal nutritional intervention. Several definitions of malnutrition were proposed in the last years, affecting the real frequency of nutritional disorders and the timing of intervention. Diagnosis of malnutrition needs a complete nutritional assessment, which is often challenging to perform during a hospital stay. For this purpose, various screening tools were proposed, allowing patients to be stratified according to the risk of malnutrition. The present review aims to summarize the actual evidence in terms of diagnosis, association with clinical outcomes, and management of malnutrition in a hospital setting.
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Affiliation(s)
| | | | | | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (F.B.); (A.l.B.); (S.Q.)
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Baldemir R, Öztürk A, Eraslan Doganay G, Cirik MO, Alagoz A. Evaluation of Nutritional Status in Hospitalized Chronic Obstructive Pulmonary Disease Patients and Can C-reactive Protein-to-Albumin Ratio Be Used in the Nutritional Risk Assessment in These Patients. Cureus 2022; 14:e21833. [PMID: 35291523 PMCID: PMC8895676 DOI: 10.7759/cureus.21833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/08/2022] Open
Abstract
Background Malnutrition is common in patients diagnosed with chronic obstructive pulmonary disease (COPD). CRP/albumin ratio (CAR) can be used as a parameter to evaluate the inflammatory process and nutritional status together. The aim of this study was to make a general evaluation of the nutritional status of hospitalized patients with COPD and to investigate whether CAR can predict nutritional status in these patients. Methods Patients who were hospitalized with COPD who were consulted to the nutrition department were included in the study. The patients' Nutritional Risk Score-2002 (NRS), demographic data, diagnoses, body mass indexes (BMI), nutritional support applied to the patients were recorded. CRP, Albumin, and CAR values of the patients were determined. Patients recommended nutritional follow-up, total parenteral nutrition (TPN) or enteral nutrition (EN) initiated, and oral nutritional supplement (ONS) support were identified. Results A total of 393 patients with COPD were analyzed. 88.55% of the patients were in the NRS ≥ 3 risk group. TPN treatment was started in 10.2% of the patients, EN in 10.9%, ONS in 76.3%, and nutritional follow-up was recommended in 2.5% of the patients. While albumin level was lower in patients with NRS ≥ 3, CRP and CAR were higher in patients with NRS ≥ 3 (p < 0.05). There was a negative correlation between NRS-2002 and albumin (p < 0.001). A positive correlation was observed between NRS-2002 and CRP and CAR (p < 0.001). Age and CAR were found to be effective in predicting those with NRS-2002 ≥ 3. The cut-off value for CAR was accepted as 3.26. Conclusions The need for nutritional support is high in patients hospitalized with COPD. It is important to evaluate nutritional support needs in these patients, regardless of NRS-2002 and BMI. In this respect, the clinician's observation and the decision are as valuable as the scoring that determines malnutrition. We think that the cut-off value of 3.26 determined for CAR can be used in the nutritional risk assessment in patients with COPD.
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Affiliation(s)
- Ramazan Baldemir
- Anesthesiology and Reanimation, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ayperi Öztürk
- Chest Disease, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Guler Eraslan Doganay
- Anesthesiology and Reanimation, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Mustafa Ozgur Cirik
- Anesthesiology and Reanimation, Ankara Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ali Alagoz
- Anesthesiology and Reanimation, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
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